Randomized Controlled Trial
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2019; 10(9): 310-326
Published online Sep 18, 2019. doi: 10.5312/wjo.v10.i9.310
Single- and double-dose of platelet-rich plasma versus hyaluronic acid for treatment of knee osteoarthritis: A randomized controlled trial
Mehdi Tavassoli, Nasser Janmohammadi, Akram Hosseini, Soraya Khafri, Seyed Mokhtar Esmaeilnejad-Ganji
Mehdi Tavassoli, Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol 47176-47745, Iran
Nasser Janmohammadi, Department of Orthopedics, Babol University of Medical Sciences, Babol 47176-47745, Iran
Akram Hosseini, Department of Pathology, Faculty of Medicine, Babol University of Medical Sciences, Babol 47176-47745, Iran
Soraya Khafri, Biostatistics and Epidemiology Department, Medicine Faculty, Babol University of Medical Sciences, Babol 47176-47745, Iran
Seyed Mokhtar Esmaeilnejad-Ganji, Clinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol 47176-47745, Iran
Author contributions: Tavassoli M and Esmaeilnejad-Ganji SM contributed in study design; Janmohammadi N, Hosseini A and Khafri S contributed in advising on study design; Tavassoli M and Esmaeilnejad-Ganji SM contributed to data collection; Khafri S contributed in data analysis; Tavassoli M and Hosseini A contributed in writing the draft; Esmaeilnejad-Ganji SM and Janmohammadi N contributed in manuscript revision; all authors approved the final version of the manuscript.
Supported by Vice Chancellor for Research and Technology of Babol University of Medical Sciences, No. 970568.
Institutional review board statement: This study was reviewed and approved by the Ethical Research Committee of Babol University of Medical Sciences (code: IR.MUBABOL.HRI.REC.1397.082).
Clinical trial registration statement: This trial was registered in the Iranian Registry of Clinical Trials with the number IRCT20180129038548N1.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to declare.
CONSORT 2010 statement: The manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Seyed Mokhtar Esmaeilnejad-Ganji, MD, Associate Professor, Department of Orthopedics, Babol University of Medical Sciences, Ganjafrooz Street, Babol 47176-47745, Mazandaran, Iran. smsnganji@yahoo.com
Telephone: +98-11-32199936 Fax: +98-11-32190181
Received: March 6, 2019
Peer-review started: March 8, 2019
First decision: April 16, 2019
Revised: May 10, 2019
Accepted: August 12, 2019
Article in press: August 13, 2019
Published online: September 18, 2019
Abstract
BACKGROUND

Platelet-rich plasma (PRP) and hyaluronic acid have been shown to be useful in the treatment of knee osteoarthritis. However, investigations comparing the efficacy of these two drugs together are insufficient.

AIM

To compare the outcomes of PRP vs hyaluronic acid injections in three groups of patients with bilateral knee osteoarthritis.

METHODS

This randomized controlled trial study involved 95 patients. Thirty-one subjects received a single injection of PRP (group PRP-1), 33 subjects received two injections of PRP at an interval of 3 wk (group PRP-2) and 31 subjects received three injections of hyaluronic acid at 1-wk intervals (group hyaluronic acid). The patients were investigated prospectively at the enrollment and at 4-, 8- and 12-wk follow-up with the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Visual Analogue Scale questionnaires.

RESULTS

Percentages of patients experiencing at least a 30% decrease in the total score for the WOMAC pain subscale from baseline to wk 12 of the intervention were 86%, 100% and 0% in the groups PRP-1, PRP-2 and hyaluronic acid, respectively (P < 0.001). The mean total WOMAC scores for groups PRP-1, PRP-2 and hyaluronic acid at baseline were 63.71, 61.57 and 63.11, respectively. The WOMAC scores were significantly improved at final follow-up to 42.5, 35.32 and 57.26, respectively. The highest efficacy of PRP was observed in both groups at wk 4 with about 50% decrease in the symptoms compared with about 25% decrease for hyaluronic acid. Group PRP-2 had higher efficacy than group PRP-1. No major adverse effects were found during the study.

CONCLUSION

PRP is a safe and efficient therapeutic option for treatment of knee osteoarthritis. It was demonstrated to be significantly better than hyaluronic acid. We also found that the efficacy of PRP increases after multiple injections.

Keywords: Platelet-rich plasma, Hyaluronic acid, Osteoarthritis, Knee, Pain

Core tip: Studies comparing the efficacy of platelet-rich plasma (PRP) and hyaluronic acid in treatment of knee osteoarthritis are insufficient. In this randomized controlled trial study, we compared the outcomes of PRP versus hyaluronic acid injections in three groups of patients with bilateral knee osteoarthritis. It was observed that PRP is significantly more efficient than hyaluronic acid. We also found that the efficacy of PRP increases after multiple injections. PRP was a safe treatment in our study, and no major adverse effects were found.